HIV/AIDS, Surgical Complications And Challenges, The Nigerian Experience

Irowa, Omorodion

doi:10.4314/bjpm.v9i1.47373

Cited by 3 publications

(8 citation statements)

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“…Clearly, this is a very different case mix from the acute abdomen that the general surgeon sees in the non-HIV population [15] . Again the commonest disease processes, CMV colitis, B-cell lymphoma, acute appendicitis and atypical mycobacterial infection are quite different from those in the non-HIV population HIV [1–4] . Appendicectomy and colectomy are the commonest abdominal operations in AIDS patients [1,4,15] .…”

Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 87%

“…However, CD4 studies of the value of viral loads and CD4 counts (alone or in combination) in predicting operative morbidity and mortality did not produce conclusive results and these tests are not ideal for every day practical use [4] . The four factors that have been found to increase operative morbidity and mortality in HIV/AIDS patients are (a) a compromised physiological state-as in general surgery the best predictors of perioperative morbidity and mortality appear to be scores that measure general health such as ASA (American Society of Anaesthesiology) risk classes or the Korsakoff's performance scale; (b) physiologically demanding surgery; (c) emergency surgery as opposed to elective procedures and (d) operations in contaminated fields, such as anorectum or oral cavity [1–4] . Patients with early HIV infection have an operative risk almost equal to HIV-negative patients and can therefore be subjected to any major surgery that is required [1,4] .…”

Section: The Heterogeneity Of Hiv/aids Patientsmentioning

confidence: 99%

“…Patients may also present to the surgeon with less severe abdominal pain that does not amount to an emergency. Infectious causes are particularly common and many cases are associated with cryptosporidial infection of the gut and a few with CMV, but there remain up to one-third of patients in whom no associated infections are uncovered [1–4] . AIDS related sclerosing cholangitis is associated with marked abnormal liver function tests (alkaline phosphatase of over 400 iu/l) and abdominal pain.…”

Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 99%

“…These factors have led to an increased indication for diagnostic laparoscopy. Care should be taken, however, during laparoscopy by insisting upon using disposable ports with a vestibular flange to prevent splash back, and by deflating the abdomen prior to port withdrawal because any aerosol emanating from the port entry wound will harbour HIV [1–4] .…”

Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 99%

“…Human immunodeficiency virus (HIV) is an RNA retrovirus that infects human T lymphocytes [1–4] . The suppressed cellular immunity manifesting as AIDS allows the development of malignancies (Kaposi's sarcoma, lymphoma) and opportunistic infections ( pneumocystis jiroveci pneumonia, cryptosporidium , cytomegalovirus (CMV), herpes simplex virus (HSV), disseminated tuberculosis and candida 5–10years later [5,6] .…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal surgery and the acquired immune deficiency syndrome

Weledji

Nsagha

Chichom

et al. 2015

Annals of Medicine &Amp; Surgery

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Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation.

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Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 87%

Section: The Heterogeneity Of Hiv/aids Patientsmentioning

confidence: 99%

Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 99%

Section: Abdominal Pain In Hiv/aidsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal surgery and the acquired immune deficiency syndrome

Weledji

Nsagha

Chichom

et al. 2015

Annals of Medicine &Amp; Surgery

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The impact of acquired immune deficiency syndrome on colorectal surgery

Weledji

2023

IJS Short Reports

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The patients infected with the human immunodeficiency virus are not a homogeneous group and are generally living longer on human active antiretroviral therapy. They are amenable to the colorectal diseases in the general population for which colorectal surgery is safe and effective. Surgical intervention is obligatory in life-threatening surgical correctable disease, but aggressive surgical intervention must be undertaken with caution and adequate perioperative care is required. A close liaison between the human immunodeficiency virus/acquired immune deficiency syndrome physician and the surgeon will decrease negative laparotomies and exclude preterminal cases. The knowledge of anorectal sexually transmitted diseases is important, and the symptomatic improvement of anorectal pathology in acquired immune deficiency syndrome may render delayed wound healing an acceptable complication.

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Untitled

2023

HSCTI

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The impact of the Human Immunodeficiency Virus (HIV) infection in colorectal surgical practice include the undoubted risk of surgeon's exposure, the atypical conditions that may be encountered and the outcome and long-term benefit of the surgical treatment on the background of the fact that Highly Active Antiretroviral Therapy (HAART)-compliant patients are living longer, but a progression of AIDS in the HAART-naïve patients. Thus, the author questions whether colorectal surgical procedures can be safe and effective measures in HIV/ AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. Literature search on the Medline (PubMed) database, Cochrane library, science citation index, relevant chapters in specialized texts on original published studies on the impact of HIV/AIDS on colorectal surgery and, the author's colorectal work on HIV/AIDS patients in the sub-Saharan country, Cameroon, W/ Africa resulted in the following observations [1]. HIV/ AIDS patients are not a homogenous group. Clinical AIDS, lower CD4 counts and poor performance status are associated with poor surgical outcome. Anorectal complaints (40%) and abdominal pain (20%) are common [2]. The commonest disease processes-CMV colitis, B-cell lymphoma, acute appendicitis (CMV/ lymphoma-associated) and atypical mycobacterium avium intracellular (MAI) are associated with high level of immunosuppression and poor outcome [3]. Less than 1% require emergency laparotomy. Appendicectomy and colectomy are the commonest abdominal operations but emergency subtotal colectomy and ileostomy for toxic megacolon carries a high mortality. HAART improves resistance to infection, nutritional status and ability to withstand surgery but has not impacted on the anorectal disorders. Surgical interventions for life-threatening correctable

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HIV/AIDS, Surgical Complications And Challenges, The Nigerian Experience

Cited by 3 publications

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Gastrointestinal surgery and the acquired immune deficiency syndrome

Gastrointestinal surgery and the acquired immune deficiency syndrome

The impact of acquired immune deficiency syndrome on colorectal surgery

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